Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome.

The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.

Prevalence of leakage and its negative impact on quality of life in people living with a stoma in the UK.

BACKGROUND: People with a stoma are reported to experience leakage, which negatively impacts patient quality of life (QoL). AIM: To assess the impact of leakage experienced by individuals with a stoma in the UK. METHODS: Data were analysed from 301 patients living in the UK who completed a questionnaire concerning the physical and psychosocial impact of living with a stoma. FINDINGS: Most respondents had had their stoma for more than 5 years. Nine out of 10 worried about leakage to varying degrees and half the respondents accepted that this was a worry they had to live with. Almost 70% experienced leakage onto clothes within the preceding year, and 28% experienced this monthly. Peristomal skin complications were experienced by 82% of respondents, the severity of which correlated with reductions in QoL. CONCLUSION: Despite the consequential negative impact of leakage on QoL, individuals are not seeking advice to resolve leakage-related issues, including from their specialist stoma care nurse.

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products.

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year (https://ascnuk.com/). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.

Using silicone technology to maintain healthy skin in stoma care.

The use of silicone in stoma care has grown in recent years and may be considered the next step in the revolutionary development of stoma-care products. Clinical nurse specialists aim to provide evidence-based care at all times, and the same is true for stoma-care nurses. Preventing harm by choosing products that have a sound research base provides the patients with up-to-date, quality care, which enables them to adapt to life with a stoma and return to 'normal' functioning. This article explores the issue of peristomal skin problems and the development of silicone products, and highlights scenarios where it could be an advantage to choose a silicone product.

Service usage of a cohort of formerly homeless women in Aotearoa New Zealand.

PURPOSE: The aim of this paper is to explore government service usage across the domains of health, justice, and social development and tax for a cohort of formerly homeless people in Aotearoa New Zealand, focusing specifically on the experiences of women. The Integrated Data Infrastructure is used, which links our de-identified cohort data with administrative data from various Aotearoa New Zealand Government departments. RESULTS: Of the cohort of 390, the majority (53.8%) were women. These women were more likely to be younger (57.1% were aged 25-44), indigenous Maori (78.6%), and have children (81.4%). These women had lower incomes, and higher rates of welfare benefit receipt, when compared to men in the cohort and a control group of women from the wider population. CONCLUSIONS: The cohort were primarily female, younger, Maori, and parents. They earned much less than their non-homeless counterparts, and relied heavily on government support. The neoliberalisation of the welfare state, high rates of women's poverty, and the gendered nature of parenthood means that women's homelessness is distinct from men's homelessness.

Patterns of Use of Vaping Products Among Smokers: Findings from the 2016-2018 International Tobacco Control (ITC) New Zealand Surveys.

Alternative nicotine products like e-cigarettes could help achieve an end to the epidemic of ill health and death caused by smoking. However, in-depth information about their use is often limited. Our study investigated patterns of use of e-cigarettes and attitudes and beliefs among smokers and ex-smokers in New Zealand (NZ), a country with an 'endgame' goal for smoked tobacco. Data came from smokers and ex-smokers in Waves 1 and 2 of the International Tobacco Control (ITC) NZ Survey (Wave 1 August 2016-April 2017, 1155 participants; Wave 2, June-December 2018, 1020 participants). Trial, current and daily use of e-cigarettes was common: daily use was 7.9% among smokers and 22.6% among ex-smokers in Wave 2, and increased between surveys. Use was commonest among 18-24 years and ex-smokers, but was similar among Maori and non-Maori participants, and by socio-economic status. Most participants used e-cigarettes to help them quit or reduce their smoking. The most common motivating factor for use was cost and the most common barrier to use cited was that e-cigarettes were less satisfying than smoking. The findings could inform developing interventions in order to maximise the contribution of e-cigarettes to achieving an equitable smoke-free Aotearoa, and to minimise any potential adverse impacts.

Well Homes Initiative: A Home-Based Intervention to Address Housing-Related Ill Health.

BACKGROUND: Six thousand children are hospitalized each year in New Zealand with housing sensitive conditions, and 86.2% of these children are rehospitalized during childhood. The Healthy Homes Initiative, set up by the Ministry of Health, and implemented in Wellington through Well Homes, carries out housing assessments and delivers a range of housing interventions. METHOD: Housing assessments were carried out by trained community workers. Philanthropic funding was received for the interventions through a local charitable trust. RESULTS: Well Homes saw 895 families. Mold in the home was the most commonly recorded area of poor housing quality, in 836 homes (93%). Partial or complete lack of insulation was also common, with 452 records (51%) having a documented need for further assessment and either an upgrade or full installation. Eighty-three percent of homes had insufficient sources of heating. A total of 5,537 interventions were delivered. Bedding, heaters, and draft stopping were delivered over 90% of the time. In contrast, insulation and carpets were only delivered 40% of the time. Interventions were least likely to be delivered in private rental housing. DISCUSSION: Targeted interventions using social partnerships can deliver housing improvements for relatively little health spending. Well Homes provides immediate and practical interventions, education, connection with social agencies, and advocacy for more substantial structural home improvements to help families keep their home warmer, drier, and healthier. This approach will be strengthened when combined with a new regulatory framework to raise the standards of private rental housing.